Committee
Audit Committee, 23 Jan 2007
23 Jan 2007 · S2 · Audit Committee
Item of business
“Implementing the NHS consultant contract in Scotland”
I will pick up on two issues. Now that we have done the work and received the response, the question is whether, at a gut level, we honestly feel that there would be significant differences if the department went through the process again. The significant point for me is the one that Susan Deacon made, which is that, as long as we take the basic line that all NHS contracts should be negotiated for the whole United Kingdom, we will have a problem, as the differences between Scotland and the rest of the UK will always be seen as peripheral to the major issue. The consultant contract is probably the most extreme example of that, because there are significant differences in relation to private sector involvement for consultants.I would be much happier if we had a more robust response from the department saying that it was going to consider how it can better reflect Scotland's needs in future negotiations. From the response, it seems that we are in a slightly better situation, as some of our points have been accepted, and some of the department's comments are reasonable but, overall, I do not get the sense that the department shares the committee's concern that the department should be doing further work. I sense a slight complacency. Perhaps I am being harsh on the department, but I would have liked a little more robustness in the response.I will be slightly parochial and talk about the examples of good practice from NHS Lothian that are in appendix A, which are the sort of issues that I hear about locally. Two of the four examples are basically about freeing up consultant time by giving a job to somebody else. Did we have to pay consultants a lot more money so that they could give their job to somebody else? Their workload was reduced and their pay packet was increased, which is a pretty good contract if you can get it—most of us round the table would love to have that. The question that must be asked is how many of the examples that are given in appendix A could not and would not have been achieved without the consultant contract. What we have in appendix A is a complete load of fluff. It lists all sorts of good measures in the NHS throughout Scotland that we all support and applaud because, to a large extent, they show the flexibility of other staff in the NHS. I am not saying that the things in appendix A are not good things, but how many of them could not and would not have happened without the consultant contract? If we looked into that, we would probably find that the answer is a minority of them.
In the same item of business
The Convener:
Ind
Item 4 is a response from the Health Department, in the name of Kevin Woods, to our report on the consultant contract. I invite members to comment before Aud...
Robin Harper:
Green
Towards the end of the response, Mr Woods admits to contract mistakes. However, he says that patients have benefited from reforms and he highlights the move ...
Margaret Jamieson:
Lab
That raises a question. The difficulty is that the contract does not talk about outcomes. Perhaps that is a problem that some of us feel should have been ove...
Mr Welsh:
SNP
Page 13 of the response quotes from our report, which states:"The Committee is of the view that current monitoring arrangements are not sufficient, particula...
The Convener:
Ind
Anything from other members?
Margaret Jamieson:
Lab
If I may just get to this; I am not going to go through—
The Convener:
Ind
If I may first make a more general point, I am concerned about the extent to which many of the responses from the Health Department start with "Noted", rathe...
Margaret Jamieson:
Lab
As well as there being a high number of instances of "Noted", there is also a mixture of "Not agreed" and "Disagree". To me, those alternative wordings indic...
The Convener:
Ind
It has already been drawn to my attention that the response mentions changes that might have been achieved anyway.
Margaret Jamieson:
Lab
Other health boards did it.
Susan Deacon (Edinburgh East and Musselburgh) (Lab):
Lab
I have some sympathy with the comments that Margaret Jamieson just made. Although I accept that many of the examples of good practice that are listed have be...
The Convener:
Ind
It is irritating that, with many of the issues on which the response is "Noted", when one reads what the department says, it is clear that it should have sai...
Margaret Smith (Edinburgh West) (LD):
LD
I will pick up on two issues. Now that we have done the work and received the response, the question is whether, at a gut level, we honestly feel that there ...
The Convener:
Ind
I draw your attention to paragraph 81, on the pay structure, and paragraph 84, on the future of the contract, where we mention aspects of evidence. We are ju...
Mr Welsh:
SNP
We are touching on matters that are fundamental to the work of the Parliament. We are talking about the accuracy and applicability of the data and informatio...
The Convener:
Ind
There are seven areas in which the department agrees with us. Members are free to comment on those as well.
Margaret Jamieson:
Lab
Andrew Welsh commented on the accuracy of data. Forgive me for focusing on the Executive's comment on the health board in my area but, under the heading "NHS...
Mrs Mary Mulligan (Linlithgow) (Lab):
Lab
I agree with many of the points that have been made. I will not repeat them. I am a little concerned that the Health Department seems to be justifying the co...
The Convener:
Ind
That is because it has stepped aside from the target.
Mrs Mulligan:
Lab
Yes. Although the detailed response that is provided about advertising and follow-ups is fine as far as it goes, I would have expected something in it about ...
The Convener:
Ind
It is noted that the Executive's answer to our recommendation in paragraph 81 is that it stepped aside from a target of 600 and achieved an increase of 389.
Susan Deacon:
Lab
Notwithstanding the comments and criticisms that we have all made, it is important for us to make wider comments and not to lose sight of the big picture. Th...
Robin Harper:
Green
A theme that has run through all our comments is that there is a lack of willingness to get to grips with the problems. I want to go back to Margaret Jamieso...
The Convener:
Ind
I invite Caroline Gardner to respond on behalf of Audit Scotland.
Caroline Gardner:
Two broad points are worth making. On the issue of looking ahead and learning lessons from the consultant contract, we are pleased about the acknowledgement ...
The Convener:
Ind
Now that we have all commented, the next question is how we respond to the department's response. Obviously, we could draft a letter to raise a number of poi...
Mr Welsh:
SNP
At the very least, I would like a response to the comments that have been made about how the committee's reports have been reacted to. I believe that they ha...
Mrs Mulligan:
Lab
It is important to ensure that the Health Department is aware of our concerns about the response. We should note both the points where the response has been ...
The Convener:
Ind
Is the committee agreed that I should write to Dr Woods in the strongest possible terms? Also, given what Andrew Welsh has said about the broader issue of ho...
Margaret Smith:
LD
I have a small point to make on the back of what Mary Mulligan said, which I totally agree with. There is a terrible temptation, at this point, to fling ever...